We often see patients with diabetic retinopathy in our daily clinics delaying treatment or being overly anxious and affecting their normal life because they do not understand the relevant knowledge, so I quote my teacher, Prof. Youxin Chen, answering patients’ questions to popularize the basic knowledge of glycoplasty.
I. What is the danger of diabetic retina?
A: In a word: very serious! With the development of China’s national economy and lifestyle changes, people are living a better life, but the incidence of diabetes is increasing year by year. According to statistics, the number of people with diabetes in China is more than 40 million, of which about 30% may already have diabetic retinopathy, so that the number of patients with diabetic retinopathy, China should have 10 million, and the vision of this is seriously threatened may be about 3 million. Even in a developed country like the United States, diabetes-induced blindness is estimated at 12,000-24,000 people per year. As ophthalmologists, we see patients blinded by diabetes almost every day, and therefore feel a heavy burden on our shoulders.
Second, if I have diabetes, is it certain that I will develop diabetic retinopathy?
A: No. The occurrence of diabetic retinopathy depends on the duration of the disease, the control of blood sugar, blood pressure, blood lipids and individual differences. Generally speaking, diabetic retinopathy does not occur after the onset of diabetes, but after 7-8 years, diabetic retinopathy will slowly start to bleed, and it will get worse with time. Of course, if your blood sugar, blood pressure and lipids are well controlled, your lifestyle is healthy, and you have a good attitude, you may have late onset of lesions, and we have seen people with diabetes for more than 50 years without lesions in the fundus. Individuals also vary greatly, and some individuals develop diabetic retinopathy despite good glycemic control. In addition, diabetic retinopathy occurs early and severely in type 1 diabetes, while retinopathy occurs later in type 2 diabetes.
3. How to detect diabetic retinopathy?
A: It is important to emphasize that diabetic retinopathy is the easiest to detect because the fundus can be seen directly by the ophthalmologist. However, many patients, not paying much attention to this point, or poor medical conditions, do not have the opportunity to see an ophthalmologist, thus delaying treatment is very unfortunate. This will help the diabetologist to determine how long the patient has had diabetes. Diabetes is a painless disease in its early stages, and some people are careless and do not easily find out that they have diabetes, only to come to the ophthalmology department and see that the fundus has been bleeding profusely, that the diabetes has been there for more than 5 years, and that it is not controlled at all, and that they still eat and drink a lot. We have encountered many patients with vision loss in the clinic, and when they look at the typical diabetic retinopathy in the fundus, we say “you have diabetes”, many patients do not believe it, thinking that I am fine, how can I have diabetes? This is a case of being too insensitive to your own health condition. It is recommended that everyone should have regular health checkups. In addition, it is recommended to alternate between left and right eye vision frequently to detect monocular disease. If there is blurred vision, go to the eye examination as soon as possible. In general, fundoscopy, or fundus color photography can confirm the diagnosis, but if there are hemorrhages in the fundus, it is better to have a fundus fluorescence angiography, which can see the extent of diabetic retinopathy more clearly.
4. Do I have to get laser treatment for diabetic retinopathy?
A: No. It is really the hardest thing to say about whether or not to have laser for diabetic retinopathy. There are two conditions to be treated with laser, one is macular edema. Many studies have shown that careful weak dispersed laser photocoagulation in the macula can reduce the leakage of blood vessels, thus reducing edema and improving visual acuity. Secondly, when neovascularization is found in the retina, or there is a large area of retinal blood vessels without blood supply, then in order to make the neovascularization shrink or stop the growth of neovascularization, so-called whole retinal laser photocoagulation is performed.
It is important to emphasize the importance of laser photocoagulation in the treatment of diabetic retinopathy. Without laser photocoagulation, there is no telling how many patients would have gone blind. Proper laser photocoagulation is the protector of vision for patients with diabetic retinopathy! Moreover, laser is never a matter of 1 or a few shots. For patients with diabetic retinopathy, laser treatment may be required at any time during the course of regular review. As for how and when to laser this is really a matter for the physician and the patient himself does not need to know too much. In general, whole retina laser photocoagulation will be done in 3-4 sessions, and it is not advocated that too much is done at once, which can cause increased edema.
Many patients, because there is no timely laser, vitreous hemorrhage, retinal neovascularization, formation of mechanized proliferative membrane, retinal detachment, falling to the point of blindness; on the contrary, if the laser is timely and appropriate, can completely avoid the occurrence of this situation.
V. Why did my vision decrease after laser treatment?
A: Laser treatment is a thermal burn effect, the less important part of the destruction, throwing pawns to protect the car, not without harm, but based on the long term, if not very good laser treatment, may be blind, and after the laser, there may be a little loss of vision, this is a contradiction, but not because of this is not laser, vision loss is better than blindness! In fact, not every patient’s vision must decrease after laser, there are also vision improvement, so there is no need to be afraid. Of course, there are some experience issues here, but the general direction of laser treatment for diabetic retinopathy is right.
Is there any other way to treat diabetic retinopathy besides laser?
A: In recent years, medical technology has advanced rapidly, especially the emergence of anti-new angiogenic drugs, making more treatment options available for diabetic retinopathy. For example, laser treatment combined with vitreous injection of anti-new angiogenic drugs will have better effect on controlling macular edema; for example, for cases with neovascularization, vitreous injection of anti-new angiogenic drugs can help the regression of new blood vessels, especially when the new blood vessels on the optic nerve papilla cannot be lasered; in some cases of advanced diabetic retinopathy where surgery is necessary, it is also possible to first In some cases of advanced diabetic retinopathy where surgery is necessary, drugs can also be injected first and then operated on, which can reduce intraoperative bleeding.
How to deal with neovascular glaucoma caused by diabetes mellitus?
A: We have dealt with many such patients. It is very critical to control the IOP in the shortest possible time, because if the IOP is very high and not controlled, the optic nerve will be atrophied and it will be too late.
VIII. What kind of conditions must be treated surgically for diabetic retinopathy?
A: If the diabetic blood glucose is not well controlled, nor is the correct laser treatment in time, and the retinopathy develops to the proliferative stage, the vitreous hemorrhage is not absorbed for more than 1 month, or the retina has proliferative membrane with retinal detachment, which affects the central vision, surgery must be performed. The purpose of surgery is to remove the hemorrhage, peel off the proliferative membrane, reset the retina, and further enhance the laser photocoagulation treatment.
Two points must be reminded: First, it is now unanimously accepted that surgery should be done early and not delayed. Generally, if the bleeding cannot be absorbed in about one month, surgery and laser should be performed. Do not wait until the proliferative membrane is formed, there are many new blood vessels, and the retinal detachment is so large that the proliferative membrane cannot be peeled off during surgery; secondly, we should realize that once the diabetic retinopathy reaches the proliferative membrane, the efficacy of surgery is generally unsatisfactory. Do not expect too much in this regard.
Therefore, once again: close review, follow-up, early treatment, including laser and surgery, must be early! Never because diabetes does not hurt, and ignore the hospital examination, ignore the blood sugar control, then regret too late, no one can help!
Nine, a few recommendations.
1, to learn to live with diabetes. There is no cure for diabetes, so you must face the reality and defy it strategically, but you must pay attention to it in your life, be checked regularly in a large hospital, form a routine, and get your blood sugar, blood pressure and blood lipids under control! Especially don’t eat and drink a lot, smoke and drink a lot.
2, firm confidence. A large number of multicenter studies have shown that: correct and timely intervention can make more than 90% of diabetic retinopathy patients avoid blindness. Regular eye examinations are especially important here, and timely laser and adequate laser are especially important!
3.The combined application of new therapeutic measures can achieve better results in the treatment of diabetic retina, such as the application of anti-angiogenic drugs.
4, Finally, once again: diabetic retinopathy can be controlled! It is especially important to control the troika of blood glucose, blood pressure and blood lipids! Timely eye examinations and regular eye reviews are especially important! Treatment early!